Provider Demographics
NPI:1023544210
Name:IRWIN, LUCAS WADE (DO)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:WADE
Last Name:IRWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-2100
Mailing Address - Country:US
Mailing Address - Phone:814-765-2950
Mailing Address - Fax:814-765-0173
Practice Address - Street 1:502 PARK AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2100
Practice Address - Country:US
Practice Address - Phone:814-765-2950
Practice Address - Fax:814-765-0173
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine